Case Management Quality Control Analyst

**BI-LINGUAL IN BOTH ENGLISH & SPANISH IS A +**

Mercalis is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Backed by proven industry expertise and results-driven technology, Mercalis helps navigate the complex life sciences marketplace by providing commercialization solutions to accelerate value and enhance patient lives.

Mercalis fosters a culture that encourages individuality and provides opportunities for creativity, growth, and success while fostering a team environment. We are a diversity-driven organization with an inclusive approach to delivering patient-centric solutions that, eliminate barriers for patients, and increase patient access to life altering medications.

The Case Management Quality Control Analyst is responsible for reviewing and evaluating the performance of the Program Representatives as they complete their cases and represent Mercalis Market Access and our clients to patients, providers, and pharmacies. This position requires the ability to work in a constructive, impartial, and collaborative manner by establishing positive work relationships, partnering with the Market Access Leadership team, Training, and Client base. This position requires the ability to gain the confidence and trust of others by demonstrating professionalism and expertise in an ever-changing environment.

• Reviews and evaluates the performance of all representatives using an approved quality scorecard in the areas of patient experience, Federal and Drug Administration (FDA) regulations of Adverse Events (AE)/Product Complaints (PC) and Health Insurance Portability and Accountability Act (HIPAA) compliance, and specific program policies and procedures
• Analyzes potential call trends through call monitoring and works with the internal departments to develop solutions to improve the patient experience
• Maintains a thorough understanding of company Standard Operating Procedures (SOPs), process and policy requirements
• Prepares and analyzes internal quality reports for management staff to review
• Manages disputes and call requests received through ServiceNow portal.
• Participates and/or facilitates internal and external calibrations to identify Clients needs and expectations
• Facilitates new hire training and introduces program quality standards and expectations
• Prepares call records and/or corresponding documents and participates in internal and external client audit.
• Handles requests to locate specific call records from the call recording system and provides reports of findings, and edit call recordings to remove Protected Health Information as requested or according to contractual agreements
• Participates in internal department meetings as needed
• Contributes to the design of call monitoring formats and Quality standards
• Identifies and reports pharmacovigilance information as required by client(s) (i.e., Adverse Events)
• On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
• Ensure all SOPs are followed with consistency
• Conducts miscellaneous tasks or projects as assigned

• High School Diploma or equivalent required
• Minimum of 2 years of QA/QC audit experience required
• 2-3 years of customer service, reimbursement/insurance, healthcare billing, physician office or health insurance processing experience required
• Intermediate knowledge of FDA regulations of AE/PC and HIPAA guidelines
• Must be a motivated self-starter with the ability to work independently and cooperatively within a cross functional environment
• Must be able to manage priorities while working independently without direct supervision and be able to direct and manage the work of others with a high level of professionalism and integrity
• Must be flexible and have the willingness and ability to respond to changing circumstances and expectations readily punctuality and reliability
• Must be able to problem solve and make independent decisions with high level of confidence
• Must be able to collect, gather, visualize, and analyze data in detail.
• Ability to be fair and impartial
• Display a high level of professionalism, integrity, maturity, and maintain a positive attitude
• Excellent verbal and written communication and interpersonal skills
• Strong planning, time management, attention to detail and organizational skills
• Comfortable interacting with all levels of management and personalities
• Basic knowledge in MS Office (Word, Excel)
• Basic knowledge of monitoring software preferred (i.e. Zoom Call Recording, Calabrio, NICE Call Recording, etc.)
• Must be available for onsite training and/or in-person client meetings as necessary.

Why work for Mercalis?

• Diversity, Equity, Inclusion & Belonging are paramount to our culture and success. Our dedication to DEI&B is both organic and intentional
• Our Mission is rewarding and fulfilling (Patient Access to Life-Saving/Improving/Extending Medications/Treatments)
• We employ the best Talent and Tools from the Patient Access Industry (We are the Industry Leader)
• We monitor the market to ensure we offer competitive salaries and benefits.
• 401K w/ 5% matching; day-1 vestment period
• 15 days PTO
• 7 Holidays + 2 Floating Days
• Health/Dental/Vision/Life; Coverage Day-1
• Gym Reimbursement
• Volunteer Hours

*This is not an exhaustive list of benefits.

*Benefits are subject to change.

** Some positions require onsite presence and/or structured hours/shifts.